Often times, low back pain is exacerbated by a tight hip flexor, also known as the psoas. Getting adjusted can help reduce the stress on the psoas but sometimes you need a little more work in the form of a stretch. This video demonstrates how to stretch the difficult area. If the problem persists, we can do some myofascial work to break up adhesions. Look for a video of that in the not too distant future.
I have observed over the years that when patients are in chronic pain for a long time and seek help repeatedly from their medical provider, eventually, they will be diagnosed with fibromyalgia. Providers often diagnose patients with fibromyalgia as a way to encourage the patient to stop seeking care. The reality is that most of the time the provider does not have an adequate answer as to why a person has pain nor do they have any way to help. They label it, generically, as fibromyalgia. I empathize with these patients and their providers.
Fibromyalgia, one can argue, is not really a diagnosis but a description of symptoms. Etymologically, it means pain in the fibrous and muscle tissues. Most providers act like there is no real cause. Many providers assume the patient is either a symptom magnifier seeking for drugs or just emotionally unstable. In my experience, more often than not, the real issue is chronic pain and can be traced back to a source with enough work. Finding the right professional to diagnose and then to treat can be daunting, however.
The causes and treatments for chronic pain are vast. Hope can be easy to sell but is often difficult to deliver. Possible causes can be osteoarthritis (wear and tear due to time or injury), auto-immune arthritis, chronic subluxations or joint dysfunction, poor posture, stress, muscle knots, referred pain from internal organs, hormone imbalances, etc., or a combination of all of the above. When I treat someone with chronic pain, I am not always successful. Sometimes, when I am successful, it may not be long-lasting. Most people I can ease some of their discomforts, at worst, or help them heal altogether. Patience and paying attention to subtle changes is the key to figuring out what is causing the pain.
It can be daunting to figure out a path to improvement. Chiropractic is a great place to start. If improving joint function and nerve flow helps, then keep going. If the help is only very temporary, like less than a couple of days relief after months of care, then you may need to add massage or some other muscle or fascia work. After that, you will need to explore various internal issues. I would refer you to a good Naturopath or Functional Medical Specialist. Now you have to consider internal organ dysfunction. Gut issues are the most common. In addition, assessing hormone function is very important. Finally, do not rule out the psycho-somatic component. PTSD (Post Traumatic Stress Disorder) can make it so that healed physical pain lingers. The pain is no less real but one must manage their emotional issues before complete recovery is achieved. Temporal care along the way is still beneficial.
If you are suffering from chronic pain or have been diagnosed with Fibromyalgia, don’t be afraid to try a host of treatments. Start conservatively and work from there. Be wary of embellished claims of immediate or permanent relief but, also, don’t lose hope. At the very least, I am positive there is someone who can, at least, help you manage your pain.
First, let us define what sciatica actually is and is not. Sciatica is, very specifically, pain along the sciatic nerve stemming from irritation of that nerve. The sciatic nerve is formed from a conglomeration of spinal nerves in the low back which binds together into one sheath. This nerve runs under the piriformis muscle in the pelvic area, then runs in between the two parts of the biceps femoris, also known as the hamstrings. It has become common to call any pain in the leg which is suspected to come from the back, sciatica. However, sciatica is a nerve pain which is the same feeling you get when you hit your “funny bone.” Most leg pain, and consequently what most people call sciatica, is actually referred pain. That is a different post. To be a true diagnosis of sciatica, it must be nerve pain that stems from the lumbar spine and runs into the buttock and/or down the backside and middle of the thigh. Now that we have that out of the way, let’s talk about what causes it!
There you have it. Probably not a comprehensive list but definitely the most common causes. Sciatica is actually rarer than it seems. When you have it, however, it is very painful and can be difficult to treat. If you are experiencing sciatica or any type of pain or other symptoms down the leg, chiropractic can help. And, like all conditions, being prompt and consistent makes for better and quicker healing.
Rib pain can be miserable. I cannot tell you how many patients have come in to see me after visiting the Emergency Department because they suspected a heart attack or something serious. Pain in the chest, shortness of breath, radiating pain down the arm, nausea, etc. Sounds like a heart attack but all of the tests are negative. So what do you when the emergency docs send you home and tell you it is nothing? Most likely you are dealing with a rib that is either stuck or not moving in the way it is supposed to. Here are five things to do, and not to do, to help.
Ribs can definitely be tricky. Sometimes they stay in after one adjustment and sometimes they take several adjustments. Usually, the longer it is out the more adjustments it will take. The rib joints at the front where it connects to the sternum can go out, too. These are also very painful and can be adjusted, although it is a different method. Please remember that although rib pain is brutal, it is not that damaging. Stressing about it will only complicate the healing process. If you have pain to one side of the spine by the shoulder blades, in the front next to the sternum, radiating along the ribs, or all of the above, just come in and we can either help you or, at least, point you in the proper directions.
Life tends to be really hard on the discs between the vertebrae in our spines. Discs are made of a flexible cartilage with a thick fluid and a hard nucleus in the middle. Discs are designed to improve motion and provide shock absorption which makes them the most abused structure in the spine. When we bend forward, the disc bulges backward. This can cause weakness due to wear and tear on the inner posterior aspect of the disc. Likewise, placing too much strain on the top can make the disc bulge all the way around. This is seen when someone is overweight, does a lot of high impact exercises, or loads the body with too much weight like with squats.
Each time a disc bulges farther beyond its normal borders, micro-tearing occurs. Tears heal with scar tissue which is, by its nature, not as pliable and can tear again. It is possible to train scar tissue into flexibility and help it act like regular disc tissue but it takes time and training. Too often the more rigid scar tissue will tear and recreate the original problem. This is where traction or decompression comes in.
I may offend some docs who are big into decompression therapy but to me, it and traction are the same thing. I think they started using the fancier word “decompression” because they developed more sophisticated and expensive equipment and needed a word to match. I must confess, though, as a linguist, decompression does portray a clearer and more concise picture of what we are hoping to accomplish. But, I digress. With decompression or traction (and from here I will use the words interchangeably) the goal is to take away pressure from the disc. When pressure on the disc is lessened, the disc can reshape and heal.
Traction can be accomplished in a number of ways. The method I am asked about most is about home-unit to hang upside down. In this case, one straps their ankles into a clamp and then leans backward to a specified angle. Some units will allow a person to hang completely upside down. I recommend 45 degrees to start. That is usually enough to open the disc space without getting a head rush that will shorten the traction time.
There is a host of other traction devices. Most of them can be found on late night infomercials. All of have some legitimacy but some are definitely better than others. The one I have seen a lot recently has the person lying down with their heels resting on a moveable piece that pulls and moves the legs side to side. I am not sure how much traction is occurring but movement is always good. One of the better ones I have seen in the past looks like a big cushy loop that hangs in a doorway. The person is situated so that their upper back is on the ground and their pelvis and legs are parallel with the doorway. Again, the end result is the same and usually positive.
Some providers have very nice decompression machines that are extremely effective in separating the vertebrae thus decompressing the disc. With severe disc bulges and herniations, these machines can be lifesavers. The only downside is the expense which can be significant. In our office, we have available a more hands-on form of traction called flexion-distraction. The table we use flexes at the lumbar level and is spring loaded. The doctor puts one hand on the spine holding a specific level in place and uses the opposite hand to push the table down. The spine separates then accommodates as the spring pushes the table back up. If the chiropractor knows what they are doing, this a very effective form of traction and can make a big difference in the disc.
All of the forms of traction that I mentioned above address the low back. There are, however, various units for the neck, as well. There are three main types of cervical traction. One way uses a harness around the chin and base of the skull attached to a rope and pulley. These units either have a counter-weight, usually a water bag, or a tension spring. The other devices look like a collar between the shoulders and the chin/skull that expand when pumped full of air. Both are effective and mostly utilized at home. The third combines traction with an attempt to restore curvature. This unit is a wedge whereupon a person lies with their head hanging over the tall side of the wedge. Often times there is an elastic strap or a weight that pulls down from the forehead.
Whatever method you choose or whichever method is the most effective for you, the key to success, as with most things, is to apply it consistently over a significant length of time. I have a cervical traction unit that I use when my neck is hurting and I routinely have Dr. Wagnon adjust me on the flexion-distraction table. Discs, just like people, sometimes just need a break from the pressures of everyday life, traction or decompression is a great way to accomplish this.
Recently, I had a patient ask me if I ever got stressed out about trying to put all of the Humpty Dumptys back together again. I joked that I am not all the king’s horses and all the king’s men so it is not my job to put Humpty Dumpty together again. This exchange brings up an interesting point, though. Several times a day people ask me to fix them. I understand what they want and I always do my best to help them, but somewhere in the back of my mind I am thinking that their expectations are mis-focused.
My job is to adjust the joints of the body. In doing so, the nervous system is stimulated which allows the body to communicate better. Better communication leads to better function. Better function leads to proper healing. Contrast helping the body function better with fixing something and you can appreciate why I am reluctant to claim that I fix or heal anything.
Bear with me while my BA in Linguistics drives the bus for a little while. If you take a very literal definition of the word fix, it means to “fasten (something) securely in a particular place or position.” That is the opposite of what I want to do. My aim is to help joints move. Likewise, it would be the height of hubris to think that I heal people. The body heals itself. Again, my job is to help the body function better so that it can heal properly and, hopefully, quicker.
Finally, giving me the burden of “fixing” someone is an impossible task no matter how willing the participants. That is like asking your exercise equipment to get you in shape. Sure the end goal is for you to get in shape but the responsibility is on you not on the equipment. Focus on improving function and not on getting fixed and you will find that not only are your expectations in line with your goals, but that your care will also be much more effective and productive.